J DAWSON1, K L. CAMPBELL4, J C. CRAIG5, A TONG1,6, A TEIXEIRA-PINTO1,6, M A. BROWN7,8, H KIRSTEN6, M HOWELL6, R KHALID1,6, K SUD9,10,11, A THIAGALINGAM2,12, C K. CHOW12,13, V W. LEE1,2,10
1Centre For Kidney Research, The Children’s Hospital at Westmead, 2Westmead Clinical School, The University of Sydney, 3Department of Nutrition and Dietetics, St George Hospital, 4Healthcare Excellence and Innovation, Metro North Hospital and Health Service, 5College of Medicine and Public Health, Flinders University, 6Sydney School of Public Health, The University of Sydney, 7Department of Renal Medicine, St George Hospital, 8St George and Sutherland Clinical School, University of New South Wales, 9Department of Renal Medicine, Nepean Hospital, 10Department of Renal Medicine, Westmead Hospital, 11Nepean Clinical School, The University of Sydney, 12Department of Cardiology, Westmead Hospital, 13Westmead Applied Research Centre, Westmead Clinical School, The University of Sydney
Aim: To evaluate the feasibility of a mobile phone text message intervention to improve dietary behaviours in people receiving haemodialysis.
Background: Nutritional management is an important, but complex, component of haemodialysis treatment. Novel strategies are needed to improve patients’ dietary adherence and self-management.
Methods: We conducted a six-month, randomised controlled trial (2:1) in patients receiving maintenance haemodialysis. Intervention participants received three semi-tailored text messages per week for six months plus usual care. The control group received usual care. The primary outcome was a composite outcome to determine feasibility, using: recruitment rate, retention rate, adherence to renal dietary recommendations and acceptability. Secondary outcomes included a range of clinical outcomes. Trial registration – ACTRN12617001084370.
Results: 130 participants were recruited (87 intervention, 43 control) from six haemodialysis units in Sydney, Australia. 48% of eligible patients consented to participate and 114 participants (88%) completed the trial. Whilst there was no significant difference in adherence to dietary recommendations at 6 months (p=0.14), there were significant reductions in dietary intake of potassium (p=0.01), phosphorus (p=0.003), sodium (p=0.031) and protein (p=0.024) in intervention participants compared to control. Compared to control participants, intervention arm had a significant increase in the number of participants meeting IDWG guidelines (p=0.005), significant reduction in average IDWG (p=0.024) and significant reduction in the number of phosphate binders prescribed (p=0.03) at 6 months. There was no difference in serum electrolytes between the 2 arms at 6 months.
Conclusion: A mobile phone text message intervention targeting dietary behaviours in people on haemodialysis is feasible and has the potential to change dietary behaviours and improve clinical parameters. Future trials evaluating the impact on patient-centred and clinical outcomes is warranted.
Jess is a PhD candidate and renal dietitian with over 10 years clinical experience. Jess’s goal is to combine her clinical practice with innovative research in nutritional management to improve care and outcomes in people with chronic kidney disease. Jess’ PhD is evaluating the impact of eHealth interventions to improve dietary care in people with chronic kidney disease.